129 workers at Liberty Hospital are being affected by lay offs. The medical facility is looking for ways to reduce expenses by $20 million.

According to a news release, the Affordable Care Act will reduce payments to hospitals from Medicare next year. The lack of expansion to the Medicaid program also prompted the hospital to cut costs. Growing bad debt is a factor in the downsizing, as patients are being forced to manage increased out-of-pocket expenses. These take the form of deductibles, co-pays and insurance premiums.

Other ways the facility may try to save money are by eliminating hospital-funded transportation and closing its wound clinic.